If a claimant has a pre-existing condition they need to be aware of the pre-existing provision prior to filing an application for disability benefits and prior to stopping work. Almost all disability insurance policies contain pre-existing condition provisions.
Most pre-existing condition provisions state that if a claimant files a disability claim related to the same medical condition that existed within the 12 months prior to obtaining disability coverage, then the subject medical condition may be excluded from coverage.
In a recent lawsuit filed against Aetna Life Insurance in New York, the claimant’s disability benefits were denied due to a pre-existing condition. The claimant worked for Sunguard Data Systems, Inc. The New York District court agreed with Aetna’s denial of disability benefits due to a pre-existing condition and on Appeal the Second Circuit Court of Appeals affirmed the claim denial.
New York Disability Lawyer Argues that New York Law Should Apply
The court in this case applied Pennsylvania law even though the policy was delivered in New York. The policy stated that Pennsylvania law applied. The claimant’s New York Disability Lawyer was trying to argue that New York Law applied so that he could attempt to invalidate the pre-existing condition provision. New York has very specific laws which limit the scope of Pre-Existing condition provisions.
About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-698-9162.